Biomedical subjects

Jack Rosenfeld

Publications and source records attributed to Jack Rosenfeld.

6 recordsLinked to original sources

PubMed2006

The effect of defined violations of test security on admissions outcomes using multiple mini-interviews.

INTRODUCTION: Heterogeneous results exist regarding the impact of security violations on student performances in objective structured clinical examinations (OSCEs). Three separate studies investigate whether anticipated security violations result in undesirable enhancement of MMI performance ratings. METHODS: Study 1: low-stakes: MMI station stems provided to a random half of 57 medical school applicants 2 weeks in advance of participation in a research study. Study 2: high-stakes: 384 medical school applicants sat a 12-station MMI to determine admission. Each half received 1 of 2 pilot MMI station stems 2 weeks in advance. Study 3: high-stakes: 38 interviewees with dual applications to occupational therapy and physiotherapy experienced the same 7-station MMI twice on the same date. RESULTS: No statistically significant differences in MMI performances were detected. CONCLUSIONS: Predictable violations of MMI security do not unduly influence applicant performance ratings.

Interviews as Topic↗

PubMed2005

Oncogenes and Angiogenesis: down-regulation of thrombospondin-1 in normal fibroblasts exposed to factors from cancer cells harboring mutant ras.

The onset of angiogenesis in cancer often involves down-regulation of endogenous angiogenesis inhibitors, of which thrombospondin-1 (TSP-1) is a paradigm. As this effect is thought to occur under the influence of transforming genetic lesions (e.g., expression of the mutant ras oncogene), its nature is regarded as intrinsic to cancer cells themselves. Here, we show that ras-transformed cancer cells can also induce TSP-1 down-regulation in their adjacent nontransformed stromal fibroblasts, but not in endothelial cells, in a paracrine and distance-dependent manner. Indeed, several H-ras-expressing fibrosarcoma (528ras1, B6ras, and NIH3T3Ras) and carcinoma (DLD-1 and IEC18Ras3) cells were found to release soluble factors capable of suppressing TSP-1 protein, mRNA, and promoter activity in nontumorigenic, immortalized dermal fibroblastic cell lines in culture (e.g., in fibroblasts expressing enhanced green fluorescent protein/TSP-1 reporter). This effect was abrogated in Id1-/- fibroblasts. At least two low molecular weight (<3 kDa), heat-labile, and trypsin-resistant mediators of TSP-1 suppression were found to be released from 528ras1 cells. Their effects on normal fibroblasts were inhibited (albeit to different extents) by pertussis toxin and, in one case, by dimethylsphingosine, none of which affected TSP-1 expression by 528ras1 cells. Collectively, our study suggests that the effect of mutant ras on tumor neovascularization is not limited to changes in angiogenic properties of cancer cells themselves. Rather, mutant ras, through a different signaling mechanism, may modulate the properties of the adjacent normal stroma, thus eliciting a proangiogenic field effect.

Animals↗

PubMed2004

Do clinical clerks provide candidates with adequate formative assessment during Objective Structured Clinical Examinations?

CONTEXT: Various research studies have examined the question of whether expert or non-expert raters, faculty or students, evaluators or standardized patients, give more reliable and valid summative assessments of performance on Objective Structured Clinical Examinations (OSCEs). Less studied has been the question of whether or not non-faculty raters can provide formative feedback that allows students to take advantage of the educational opportunity that OSCEs provide. This question is becoming increasingly important, however, as the strain on faculty resources increases. METHODS: A questionnaire was developed to assess the quality of feedback that medical examiners provide during OSCEs. It was pilot tested for reliability using video recordings of OSCE performances. The questionnaires were then used to evaluate the feedback given during an actual OSCE in which clinical clerks, residents, and faculty were used as examiners on two randomly selected test stations. RESULTS: The inter-rater reliability of the 19-item feedback questionnaire was 0.69 during the pilot test. The internal consistency was found to be 0.90 during pilot testing and 0.95 in the real OSCE. Using this form, the feedback ratings assigned to clinical clerks were significantly greater than those assigned to faculty evaluators. Furthermore, performance on the same OSCE stations eight months later was not impaired by having been evaluated by student examiners. DISCUSSION: While evidence of mark inflation within the clinical clerk examiners should be addressed with examiner training, the current results suggest that clerks are capable of giving adequate formative feedback to more junior colleagues.

Adult↗

PubMed2004

An admissions OSCE: the multiple mini-interview.

CONTEXT: Although health sciences programmes continue to value non-cognitive variables such as interpersonal skills and professionalism, it is not clear that current admissions tools like the personal interview are capable of assessing ability in these domains. Hypothesising that many of the problems with the personal interview might be explained, at least in part, by it being yet another measurement tool that is plagued by context specificity, we have attempted to develop a multiple sample approach to the personal interview. METHODS: A group of 117 applicants to the undergraduate MD programme at McMaster University participated in a multiple mini-interview (MMI), consisting of 10 short objective structured clinical examination (OSCE)-style stations, in which they were presented with scenarios that required them to discuss a health-related issue (e.g. the use of placebos) with an interviewer, interact with a standardised confederate while an examiner observed the interpersonal skills displayed, or answer traditional interview questions. RESULTS: The reliability of the MMI was observed to be 0.65. Furthermore, the hypothesis that context specificity might reduce the validity of traditional interviews was supported by the finding that the variance component attributable to candidate-station interaction was greater than that attributable to candidate. Both applicants and examiners were positive about the experience and the potential for this protocol. DISCUSSION: The principles used in developing this new admissions instrument, the flexibility inherent in the multiple mini-interview, and its feasibility and cost-effectiveness are discussed.

Adult↗

PubMed2004

The relationship between interviewers' characteristics and ratings assigned during a multiple mini-interview.

PURPOSE: To assess the consistency of ratings assigned by health sciences faculty members relative to community members during an innovative admissions protocol called the Multiple Mini-Interview (MMI). METHOD: A nine-station MMI was created and 54 candidates to an undergraduate MD program participated in the exercise in Spring 2003. Three stations were staffed with a pair of faculty members, three with a pair of community members, and three with one member of each group. Raters completed a four-item evaluation form. All participants completed post-MMI questionnaires. Generalizability Theory was used to examine the consistency of the ratings provided within each of these three subgroups. RESULTS: The overall test reliability was found to be .78 and a Decision Study suggested that admissions committees should distribute their resources by increasing the number of interviews to which candidates are exposed rather than increasing the number of interviewers within each interview. Divergence of ratings was greater within the pairing of community member to faculty member and least for pairings of community members. Participants responded positively to the MMI. CONCLUSION: The MMI provides a reliable protocol for assessing the personal qualities of candidates by accounting for context specificity with a multiple sampling approach. Increasing the heterogeneity of interviewers may increase the heterogeneity of the accepted group of candidates. Further work will determine the extent to which different groups of raters provide equally valid (albeit different) judgments.

Adult↗

PubMed2004

The ability of the multiple mini-interview to predict preclerkship performance in medical school.

PROBLEM STATEMENT AND BACKGROUND: One of the greatest challenges continuing to face medical educators is the development of an admissions protocol that provides valid information pertaining to the noncognitive qualities candidates possess. An innovative protocol, the Multiple Mini-Interview, has recently been shown to be feasible, acceptable, and reliable. This article presents a first assessment of the technique's validity. METHOD: Forty five candidates to the Undergraduate MD program at McMaster University participated in an MMI in Spring 2002 and enrolled in the program the following autumn. Performance on this tool and on the traditional protocol was compared to performance on preclerkship evaluation exercises. RESULTS: The MMI was the best predictor of objective structured clinical examination performance and grade point average was the most consistent predictor of performance on multiple-choice question examinations of medical knowledge. CONCLUSIONS: While further validity testing is required, the MMI appears better able to predict preclerkship performance relative to traditional tools designed to assess the noncognitive qualities of applicants.

Clinical Clerkship↗